Medicalizing menopause and related issues

“The International Menopause Society (IMS) joined forces this year with Novo Nordisk FemCare Ag (marketers of Activella®) to ‘end silent suffering’ and promote recommendations for the management of vaginal atrophy during the menopause. A key problem, they say, is that results of a phone survey show that women are not discussing vaginal atrophy with their practitioners, who in turn, are not openly asking questions about vaginal health.…… aren’t we being a bit alarmist about the ‘silent suffering’ of women with this chronic condition?

Mind you, I am not mocking or doubting the horrible impact that vaginal atrophy can have on a woman’s life. In fact, aging and its accompanying aches and pains aren’t fun. Neither are hot flashes, night sweats, mood swings or vaginal pain.…I hardly believe that we’re on the verge of an atrophy epidemic or that we need to dramatize the “silent suffering” countless women across the globe.”

Comments

Nancy posted on October 20, 2010 at 10:22 pm

I don’t get the sense from your column or from Liz’s that either of you know what I know, from personal experience, and that is: Menopause makes the puberty years look like a week at Club Med. It seems to me the two of you have no concept of its physical impact. Women suffering from its effects will welcome some medicalizing of what really do become chronic conditions.

Nancy – I appreciate your comment. And I would like to assure you that I am well aware of the physical impact of menopause, including night sweats, hot flashes, mood swings and insomnia. Consequently, not only do I stand by what I write, but I live it…daily.
As a women’s health advocate and medical writer/journalist, my goal is to provide information and fodder that encourages women to think about and even question the status quo when it comes to their health. For decades, women have been duped into believing that menopause is a disease that requires medical treatment, but at the same time, researchers have been unable to differentiate many of its symptoms from those of aging. Consequently, it’s imperative not only to ask what we are treating but why and how.
By all means, if you are comfortable with HRT and other treatments, go for it. But use them with eyes wide open and always examine the risks versus benefits. You might be surprised by what you learn. And how much we still don’t know.

Nancy posted on October 21, 2010 at 11:48 pm

Hello again. Actually, I’m not comfortable with the idea of HRT and I don’t use it. But you and Gary seemed to be going on the offensive at the very idea of recognizing a need to find medical solutions to menopause-associated problems. Of course those problems can be mixed up with aging. They ARE the effects of aging. But what’s wrong with saying we need medical solutions to symptoms of aging if they’re painful or debilitating, like vaginal atrophy and night sweats and certain other menopause-associated changes. We correct our vision, we use hearing aids, some people of the other gender use sildenafil — those are all medical solutions to age-related changes. Sure, having a company that produces HRT back some publicity stunt like Menopause Day makes it suspect. But still, I always thought “medicalizing” meant tricking people into thinking they need medicine for something when they really don’t. To me that doesn’t seem to be what’s happening here. Thanks.

Nancy:
Author Louise Foxcroft, writing in Hot Flushes, Cold Science, points out that “fear of the menopause is something we have learned, and it has grown out of a general, male and medical distaste for the idea of the menopause perceived as an end to viability, fertility, beauty, desirability and worth. Since the French physician de Gardanne coined the new term ‘ménépausie’ in the early nineteenth century, an onslaught of opinion, etiology, treatments, and not least and lest we forget, profit has followed. Women need to unlearn their dread and recognize that menopause is not, of itself, dread-full; that we are merely the victims of our biological process.”
We have also been victims of the fact that menopause has been “thoroughly medicalized in Western Culture.” The result?
Our bias is to think of menopause as a disease, something that needs to be fixed, treated and eliminated. The solution is inevitably hormone replacement therapy or HRT.
To add to that, in 2005, a panel convened by the National Institutes of Health issued a statement emphasizing that menopause is not a disease. And yet, western or allopathic practitioners are encouraged to keep up to date on data on medical management of menopausal symptoms.
I can’t speak for Gary but I can speak for myself: menopause is a not disease nor is it something to be feared or loathed in order for a pharmaceutical company to sell more drugs. There are natural, effective ways to address troublesome symptoms without placing ourselves at greater risk for breast cancer, ovarian cancer, heart disease, stroke, deaths from lung cancer, osteonecrosis, hip fracture and the like. That’s what pharmaceutical treatment has produced. And truly, women have been ‘tricked’ into fearing the change and taught early on that they need to prevent or reverse the effects of aging. This anti-aging attitude is pervasive, just look at skin creams, botox, lipo, vaginal rejuvenation, etc.
We could argue ad nauseum about treating versus addressing symptoms and if big bad pharma is to blame. But I’m not interested in that debate. As I stated in my last comment, my goal is to open thoughtful discussion and encourage women to educate themselves before using anything. Read, research, talk to your peers and then make a decision that is right for you. And then? Work with a licensed practitioner who’s well-versed in the strategy you want to pursue.
Want to read more? I encourage you to peruse my blog. I don’t ascribe to fear mongering, in any shape or form, especially when it comes to my body. Period. That’s my story and I’m sticking to it.

Eve posted on October 26, 2010 at 10:48 pm

Well said, Nancy. Primary care docs don’t usually ask or focus on these symptoms unless asked, although I hope that OB-GYNS have a better track record on this. That’s why it’s especially important for writers to help women understand that it is appropriate to broach these issues with a doctor. No one’s saying menopause is a disease. And if a doctor’s only suggestion for menopause-related symptoms is medication, women should be counseled to get another opinion.

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